Rashed S. Al-Rashed

Hepatitis C virus genotypes in patients with chronic liver disease and haemodialysis patients from Saudi Arabia

Summary. The genotypes of hepatitis C virus (HCV) were investigated in 28 Saudi patients (21 males, seven females; age range 23–68 years; mean 45.0 years) with histologically proven chronic hepatitis (13 chronic active hepatitis and 15 liver cirrhosis) and in 32 Saudi patients with chronic renal failure maintained on haemodialysis (22 males, 10 females; age range 18–60 years; mean 40.0 years) who also had liver disease due to HCV. Among the 28 patients with chronic liver disease genotype 4 was the predominant one (60.7%), followed by types 1b (21.4%), 1a (14.3%) and 2a (3.6%). The distribution of genotypes was similar in patients with chronic active hepatitis to those with liver cirrhosis. Among the 32 patients with chronic renal failure and maintained on haemodialysis, genotype 4 was also the dominant type (55.0%), followed by 1a (25.0%), 1b (21.9%) and 2a (3.1%). In all categories studied the prevalence of genotypes between males and females was the same. As our patients were selected from various regions of Saudi Arabia, we believe that genotype 4 is the predominant one throughout the whole kingdom.

Natural honey prevents ischaemia-reperfusion-induced gastric mucosal lesions and increased vascular permeability in rats

Objective: It has been proposed that natural honey may contain a ‘sucralfate‐like’ substance. Recent studies have shown that sucralfate affords protection against ischaemia‐reperfusion‐induced injuries in the rat stomach. Therefore, the effect of honey was studied on ischaemia‐reperfusion‐induced gastric lesions, intraluminal bleeding, vascular permeability and non‐protein sulphhydryls (NP‐SH) in the rat stomach. Methods: Rats were subjected to 30min of gastric ischaemia in the presence of 100 mM HCI and reperfusion period of 60min. Intraluminal bleeding was assessed macroscopically and the gastric lesions were graded microscopically under an inverted microscope. Vascular permeability was quantified by measuring spectrophotometrically the extravasated Evans blue dye in the stomach. NP‐SH levels were measured spectrophotometrically. A luminol‐dependent chemiluminescence method was used to assess antioxidant effects of honey in vitro. Results: There were significantly more gastric lesions, more severe intraluminal bleeding, more leakage of Evans blue and depletion of NP‐SH during the reperfusion period as compared to controls. Pre‐treatment with honey (0.078‐0.625 g/kg, orally) or dimethyl sulphoxide (0.02‐0.08g/kg, intraperitoneally) 30min before the ischaemia‐reperfusion dose‐dependently reduced the gastric lesions and intraluminal bleeding and decreased the vascular permeability. Furthermore, honey reversed the ischaemia‐reperfusion‐induced depletion of NP‐SH levels and inhibited the luminol‐dependent chemiluminescence induced in a cell‐free xanthine‐xanthine oxidase system. Conclusion: These results suggest that gastric protection by honey may be a result of its antioxidant effect. It is suggested that this property of honey may be due to the presence of a ‘sucralfate‐like’ substance.

Integration of hepatitis B vaccine into the expanded program on immunization: The Saudi Arabian experience.

Hepatitis B virus (HBV) is endemic in the Kingdom of Saudi Arabia. To prevent the chronic carriage of HBV in Saudi children, hepatitis B vaccine was added as the seventh immunogen in the expanded program on immunization (EPI). In the first year, the coverage of the first dose and third dose of HB vaccine was 90% and 73%, respectively. In a survey of 637 children, 603 (95%) were positive for antibody to hepatitis surface antigen (anti-HBs) without concomintant antibody to hepatitis B core antigen (anti-HBc) or hepatitis B surface antigen (HBsAg). A total of 592 (93%) with anti-HBs titer of > 10 IU/L were considered as responders to the vaccine. The majority (60%) of these responders had titers > 100 IU/L. Only one (0.3%) non-responder was positive for anti-HBc alone. Using historical control, the protective efficacy was estimated as 99%. Neither the gender of the recipient, schedule of the vaccination, nor the sourve of vaccine influenced the response to the vaccine. The successful integration of the HB vaccine into the EPI was due to the effectiveness of the EPI and the efficient primary health care system in Saudi Arabia.

Features of hepatic cavernous hemangioma on planar and SPECT Tc-99m-labeled red blood cell scintigraphy

PURPOSE To determine the value and diagnostic accuracy of planar and SPECT Tc-99m-labeled red blood cell (Tc-99m RBC) scintigraphy in the investigation of suspected hepatic cavernous hemangioma as found on ultrasound. PATIENTS AND METHODS One hundred patients, 89 women (89%) and 11 men (11%), between 22 and 67 years old (mean age, 38 years) were evaluated for liver masses found on abdominal ultrasound. All the patients had previous Tc-99m RBC scintigraphy. The size of the lesions ranged from 1 to 9 cm. The final diagnosis was reached through cytologic biopsy, or histopathologic tests (or all of these). RESULTS One hundred thirty lesions were found. With regard to the distribution of the lesions, 116 (89%) were single; 14 (3%) were multiple, with 118 (91%) in the right lobe and 12 (9%) in the left lobe; 83 (64%) were posterior; and 47 (36%) were anterior. With respect to the pattern of radioactivity fill-in, 86 (66%) lesions were typical and 44 (34%) were atypical. The results of Tc-99m RBC scintigraphy showed sensitivity, specificity, and positive and negative predictive and accuracy values of 97%, 83%, 98%, 77%, and 96% respectively. The use of SPECT improved the sensitivity value by 11% for lesions of 1 to 2 cm. CONCLUSIONS Tc-99m RBC scintigraphy is the noninvasive technique most helpful in the diagnosis of hepatic hemangioma, especially in those at risk for lesion rupture or bleeding. SPECT should be performed whenever planar imaging fails to show the lesion by 2 hours. The use of ultrasound should precede scintigraphy for two important reasons: the size and the location of the lesion. Location of the lesion (anterior or posterior) is important for optimal gamma camera acquisition parameters. Lesions less than 1 cm are cannot be detected because they are beyond the limit of spatial resolution of the gamma camera we used.

Tuberculous liver abscess: a case report and review of literature

Tuberculous liver abscess is rare worldwide. We report a 45-year-old man who presented with abdominal pain, fever and weight loss. Ultrasound and computed tomography of the abdomen showed multiple cystic lesions in the liver. Ultrasound guided needle aspiration revealed yellowish brownish aspirate, which was flooded with acid-fast bacilli. The abscess was drained under ultrasound guidance. Subsequent abdominal ultrasound a few days later showed resolution of the abscess cavity. He was concomitantly started on systemic antituberculous therapy. A tuberculous liver abscess has to be thought of in the differential diagnosis of liver abscesses and to consider the role of percutaneous drainage along with systemic antituberculous chemotherapy as an alternative to surgery in the management. A greater awareness of this clinical entity is required for successful treatment.

Squamous papilloma of the esophagus - a clinicopathologic study of 10 cases and review of the literature.

Esophageal squamous papilloma (ESP) is considered to be a rare finding during endoscopy or autopsy. Over a 10 year period, 10 cases were identified among 14,232 patients who were endoscoped in the King Khalid University Hospital (KKUH), Riyadh. The calculated incidence was 0.07%. There were eight males and two females whose ages ranged from 24 to 65 years. The presenting symptoms were mostly dyspepsia and heartburn. All the ESPs were single growth, most of which were located in the lower segment of the esophagus. Immunoperoxidase staining was negative for human papilloma virus in all the tissue samples. It is calculated that ESPs may not be very rare in the Saudi population. Awareness of its occurrence may lead to increasing diagnosis among endoscopy patients.

Crohn's disease in Arabs.

Crohns disease is widely described in the Western literature, but it has not been widely observed in the Middle Eastern community. We diagnosed Crohns disease in seven Arabs, three whom were Saudi Nationals. Their mean age was 32.4 years (range, 18-40 years) and duration of symptoms varied from three months to ten years. The site of the disease was ileocolic in five patients and colonic in two. Mass lesions in the abdomen were seen in three patients. Four cases were diagnosed from histological specimens obtained at laparotomy and resection and the other three were diagnosed from colonoscopic biopsy specimens. Extraintestinal manifestations were found in three patients. Surgery alone was the treatment in two patients, whereas the remaining required medical therapy, mainly steroids, with or without surgery. We conclude that Crohns disease does occur in the Arab population, but with milder systemic effects.

Praziquantel, oxamniquine, and metrifonate in the treatment of schistosomiasis in Riyadh.

This study sought to compare the effectiveness and side effects of praziquantel versus oxamniquine in treating 200 patients with Schistosoma mansoni infection and praziquantel versus metrifonate in...

The management of esophageal strictures in children.

During a 10-year period from 1982 to 1992, 36 children and infants were treated for esophageal stricture. The severity of the stricture was indicated by the degree of feeding intolerance manifested by delays in growth and development and confirmed by fluoroscopy and endoscopy. Their ages ranged from one month to seven years. During the first eight years, the initial treatment was the conventional use of Savory dilators. Balloon dilatation was applied in all patients with esophageal stricture during the last two years. According to the etiology of the stricture, patients were divided into three groups. Group A: (seven patients) due to peptic esophagitis following persistent gastroesophageal reflux (GER). Group B: (15 patients) following ingestion of corrosive material. All had severe strictures; two had stomach outlet obstruction in addition. Group C: (14 patients) following repair of esophageal atresia. There was no mortality; however, overall morbidity was 5.5%, as one patient had esophageal perforation during the initial esophageal dilatation and one patient developed anastomotic leak.